Susan McAllister

Late presentation of HIV infection among adults in New Zealand: 2005-2010.

Early diagnosis of HIV infection is important for the individual and for disease control. A consensus was recently reached among European countries on definitions of timing of presentation for care: ‘Late presentation’ refers to entering care with a CD4 count <350 cells/μL or an AIDS‐defining event, regardless of the CD4 count. Presentation with ‘advanced HIV disease’ is a subset having a CD4 count <200 cells/μL and also includes all who have an AIDS‐defining event regardless of CD4 count. This study examines timing of presentation in New Zealand from 2005 to 2010.

Unlinked anonymous HIV prevalence among New Zealand sexual health clinic attenders : 2005-2006

This unlinked anonymous study aimed at determining the prevalence of HIV among sexual health clinic attenders having blood samples taken for syphilis and/or hepatitis B serology in six major New Zealand cities over a 12-month period in 2005–2006. Overall, seroprevalence was five per 1000 (47/9439). Among men who have sex with men (MSM), the overall prevalence and that of previously undiagnosed HIV were 44.1 and 20.1 per 1000, respectively. In heterosexual men, the overall prevalence was 1.2 per 1000 and in women 1.4 per 1000. HIV remains to be concentrated among homosexual and bisexual men. Comparison with a previous survey in 1996–1997 suggests an increase in the prevalence of undiagnosed HIV among MSM and also an increase in the number of MSM attending sexual health clinics. The low prevalence of HIV among heterosexuals suggests no extensive spread into the groups identified at risk of other sexually transmitted infections.

Increase in HIV diagnoses among men who have sex with men in New Zealand from a stable low period

OBJECTIVES To describe trends in HIV diagnoses among men who have sex with men (MSM) in New Zealand 1996-2008, and to identify characteristics associated with HIV diagnoses in the resurgent phase. METHODS Data collected through routine surveillance of HIV infection, where the mode of transmission included homosexual contact, were analysed over the period 1996-2008. RESULTS Annual HIV diagnoses were low during 1996-2000, rose sharply between 2001 and 2005, and remained at an elevated plateau between 2006 and 2008. Over a quarter were attributed to HIV infection acquired overseas (28.6%). Trends in diagnoses of locally acquired HIV infection closely mirrored the trend of three diagnosis phases. Increases in locally acquired HIV occurred among virtually all characteristics of MSM. However, compared with MSM diagnosed in the low phase 1996-2000, individuals diagnosed in the resurgent phase 2001-05 were more likely to be aged 30-39, to have tested HIV-negative within the previous 2 years, to live in the Northern region encompassing Auckland, and to be of non-European ethnicity. The per capita HIV diagnosis rate among MSM was lowest in 1997, at 22.0 per million males aged 15-64, and highest in 2005 at 66.7 per million. CONCLUSION The increase in HIV diagnoses among MSM in New Zealand was primarily due to an increase in locally acquired HIV infection, which disproportionately affected some groups of MSM. Factors driving this change in local epidemic conditions need to be identified. The rate of new HIV diagnoses among MSM remains low by international standards.

Socioeconomic outcomes following spinal cord injury and the role of no-fault compensation: longitudinal study.

Study design:Longitudinal cohort study.Objectives:To estimate socioeconomic and work outcomes over 2 and a half years following spinal cord injury (SCI), and to compare those in receipt of compensation (Accident Compensation Corporation, ACC) and those not.Setting:People admitted to the two spinal units in 2007–2009 in New Zealand, where there is a unique no-fault compensation scheme for injury.Methods:Interviews were conducted at ∼6, 18 and 30 months after SCI and data collected on pre-SCI and post-SCI health and socioeconomic characteristics. Poisson regression, quantile regression and a linear mixed model regression were used to compare differences in outcomes.Results:Of the 162 eligible people, 118 (73%) participated and 91(77%) were followed to 30 months; 79% received ACC. Median personal income, self-reported standard of living and household income adequacy all fell slightly to 18 months and then stabilized at 30 months. At that time, 49% had returned to paid work. Among those not eligible for ACC, income fell to less than half the ACC group (P<0.006 after adjustment), and return to work was lower (29% versus 54%).Conclusion:The findings that most people retained their economic status and that return to work was relatively high appear to be due to the proportion entitled to the ACC no-fault compensation scheme for injury; with earnings-related compensation, a focus on rehabilitation to work and non-means-tested support services. This situation should mitigate against the downward spiral into poverty and further ill-health.

HIV diagnoses in indigenous peoples: comparison of Australia, Canada and New Zealand

In industrial countries, a number of factors put indigenous peoples at increased risk of HIV infection. National surveillance data between 1999 and 2008 provided diagnoses for Aboriginal and Torres Strait Islanders (Australia), First Nations, Inuit and Métis (Canada excluding Ontario and Quebec) and Māori (New Zealand). Each country provided similar data for a non-indigenous comparison population. Direct standardisation used the 2001 Canadian Aboriginal male population for comparison of five-year diagnosis rates in 1999-2003 and 2004-2008. Using the general population as denominators, we report diagnosis ratios for presumed heterosexual transmission, men who have sex with men (MSM) and intravenous drug users (IDU). Age standardised HIV diagnosis rates in indigenous peoples in Canada in 2004-2008 (178.1 and 178.4/100 000 for men and women respectively) were higher than in Australia (48.5 and 12.9/100 000) and New Zealand (41.9 and 4.3/100 000). Higher HIV diagnosis rates related to heterosexual contact among Aboriginal peoples, especially women, in Canada confirm a widening epidemic beyond the conventional risk groups. This potential of a generalised epidemic requires urgent attention in Aboriginal communities; available evidence can inform policy and action by all stakeholders. Although less striking in Australia and New Zealand, these findings may be relevant to indigenous peoples in other countries.

HIV prevalence among men who have sex with men in New Zealand 1985-2009: 25 years of public health monitoring.

Annual population-based estimates of the number of men who have sex with men (MSM) with diagnosed HIV infection (HIV prevalence pool), and the proportion of all MSM this represents (HIV prevalence), have been insufficiently described over the long term. We investigated the dynamic effects of ongoing HIV diagnoses, lower mortality due to treatment and growth in the MSM population over time on these two epidemic indicators using national HIV/AIDS surveillance data in New Zealand, 1985–2009. The diagnosed HIV prevalence pool rose 79% between 1989 and 1999, and 137% between 1999 and 2009. Estimates of diagnosed HIV prevalence as a proportion of MSM were 0.2% of MSM in 1985, and were between 1.5% and 5.0% of MSM by 2009. New Zealand continues to have a relatively low-prevalence HIV epidemic among MSM; however, the number of MSM living with diagnosed infection is growing rapidly 25 years after HIV testing was introduced.

Good outcome in HIV‐infected refugees after resettlement in New Zealand: population study

Background: The aims of this study were to determine the clinical characteristics on arrival and the subsequent clinical outcome of HIV‐infected UN quota refugees who settled in New Zealand during the last 11 years and to estimate their rate of HIV transmission.

Disease characteristics and treatment of patients with diabetes mellitus attending government health services in Indonesia, Peru, Romania and South Africa

To describe the characteristics and management of Diabetes mellitus (DM) patients from low‐ and middle‐income countries (LMIC).

Feasibility study of strengthening the public–private partnership for tuberculosis case detection in Bandung City, Indonesia

ObjectivePrivate practitioner’s (PPs) collaboration for detection, diagnosis and treatment of tuberculosis (TB) is recommended by the World Health Organization and encouraged by the Indonesian National TB control programme. TB case management by PPs, however, are mostly not in line with current guidelines. Therefore, we developed an intervention package for PPs comprising of TB training, implementation of a mobile phone application for notification of TB cases and a 6-month regular follow-up with PPs. This study aimed to evaluate the feasibility of the intervention package to increase TB case detection and notification rates among PPs in five community health centre areas in Bandung City, Indonesia.ResultsA total of 87 PPs were registered within the study area of whom 17 attended the training and 12 had the mobile phone application successfully installed. The remaining five PPs had phones that did not support the application. During the follow-up period, five PPs registered patients with TB symptoms and cases into the application. A total of 36 patients with TB symptoms were identified and 17 were confirmed TB positive.

The impact of repeat testing in the New Zealand antenatal HIV screening programme: a qualitative study

Objectives To investigate the impact on women, and their healthcare providers, of initial-reactive HIV test results which required re-testing in the New Zealand antenatal HIV screening programme. Methods Women with initial-reactive HIV test results from 2007 to 2011 were identified through the antenatal HIV screening programme. Semi-structured telephone interviews were undertaken with seven women and 30 healthcare providers. Responses to questions were written verbatim. Three researchers undertook preliminary coding of the interviews and identified common themes which were applied to the transcripts and key excerpts obtained. Results All of the women interviewed experienced considerable anxiety upon receiving the result, but the extent of this anxiety was rarely appreciated by their healthcare provider. Their main worries were for their own health, that of their children and family, and their relationship with a spouse or partner. Despite this stressful experience, support for the screening programme was strong. Adequate information and timely receipt of results were identified as vital. Healthcare providers also supported the programme but stressed that clear, timely and personal communication with laboratory personnel was important. Conclusions The ideal way to alleviate anxiety in women from re-testing is to limit the need for this by obtaining as much information as possible from the original sample. If re-testing is necessary, healthcare providers need to appreciate the anxiety that will arise, ensure that they have the best possible information and communicate this to the women, as soon as is practicable, in an easily understood manner.